Diabetes, lower urinary tract dysfunction (LUTD) and urinary tract infections (UTI) are common health problems in older women. Although it has been suggested that LUTD and UTI are more common in women with diabetes, little is known of prevalence, incidence, risk factors and pathogenesis of these health problems in women with diabetes. In particular, there has been limited research on specific aspects of diabetes severity (duration, treatment, glycemic control, presence of complications) that may contribute to the development or severity of lower urinary tract dysfunction and infection. We are completing the Reproductive Risk factors for urinary Incontinence Study at Kaiser (RRISK), a 2100 community- dwelling cohort of ethnically racially diverse women ages 40 to 69 on which we have extensive assessment of urinary incontinence and potential risk factors. Project #1 of our SCOR wilt follow the women for 5 years. We propose to compare 400 women with type 2 diabetes to a group of 400 women without diabetes from the RRISK cohort. To attain a sample of 400 women with type 2 diabetes, we will sample additional women from the Kaiser population using the same methods. Both groups will be followed for 5 years to determine the incidence and increases in severity LUTD and UI. We will also determine risk factors, especially measures of diabetes severity associated with increase risk. We will compare the accuracy ofnon-invasive diagnostic measures to an extensive objective exam including postvoid residual volume, uroflow and urodynamics for LUTD. We will also determine the role of biological factors that may increase risk for UTI including secretor status, secretion of IL-6 in urine and adherence of uropathogens to vaginal epithelial cells. The proposed study offers a unique and efficient opportunity to understand the natural history and possible mechanisms for LUTD and UTI in women with type 2 diabetes. Our overarching goal is to facilitate a better understanding risk factors for and pathogenesis for LUTD and UTI with the aim of guiding the development of preventive interventions.